Extradural hematoma: toward zero mortality. A prospective study.

This is a prospective analysis of 107 consecutive cases of extradural hematoma treated during the last 3 years at the Department of Neurosurgery of the University Hospital of Verona (Italy). The overall mortality was 5%; 89% of the patients made a good recovery or had only moderate residual disability. We regard this as meaningful progress compared to recent reports from other sources showing mortality rates of approximately 20%. The majority of our patients (57%) underwent operation within 6 hours of injury; 60% went into surgery with a Glasgow coma scale (GCS) score between 8 and 15. No deaths occurred among patients reaching surgery with a GCS score of 8 or better; all patients with scores of 8 to 15 made a good recovery (63 cases). Seventeen patients went into surgery while still free of neurological signs, and 8 had only one dilated pupil; all 25 made good recoveries. A flexion posture at admission cuts the chances of a good outcome by one-half; an extension posture cuts the chances to one-fourth. Ninety-five per cent of the patients had fractures of the skull; only 21% had the classical lucid interval. The cause of all 5 deaths was identified as stemming from avoidable errors in management in outlying hospitals (2 cases) or in our own department (3 cases). The results of this study indicate that zero mortality from extradural hematoma is a realistic goal for a modern, well-run care system for head-injured patients that includes prompt referral by community doctors and suitable hospital facilities for constant access to emergency neurosurgery.